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HomeMy WebLinkAboutMortgage_Marsh (3) 4, � STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year _- -t_ FOR DEDUCTION FROM ASSESSED VALUATION 'tom 20\ : -r State Form 43709(R13/10-1� *a ``;d ; Prescribed by Department of Local Government Finance Feu INSTRUCTIONS: File Mark To be filed in person or by mail. Form filed with: Filing Dates: 1) Real Property:Must be completed and dated in the calendar year for which the deduction is sought Must be filed or postmarked with the County Auditor or County Recorder of the county where the property is County Auditor located on or before January 5 of the immediately succeeding calendar year. County Recorder 2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the county where the property is located during the twelve(12)months before March 31 of each year the deduction is sought See reverse side for additional instructions and qualifications. Applicant(owner r con ct buyer-see restricts ns n reve a side C\VVi r� . PlISti 1 ( 1I,,rsh . Taxing District Key u er/legal descn tion Record nu r Page n mb j� 05--3I —1-0 0 -0o0 q J---c9? 201 t $. Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of A)lortgage on ct indebtedness unpaid ass.-off,, Is the applicant the sole assessment date,current year assessment date,current year date of scat n� '^ DO legal or ble owner? UYU Yes 0 No If no,what is his/her exact share of interest? If owned with some ne other than spouse,indicate with whom If name on record is different than that of applicant,indicate below: FILE 1 a property in question:Annually Assessed P,Real Property ElAnnualAssessed (( Mobile Home(IC fr1.1-7) Hams of mort gear tr�cY sailer N O V 2 7 2019 • Address o mortgageeee or contract\` seller(number and street city,state,and ZIP code) auat;- fgtt----- Name of assignee or other owner or holder of mortgage GIBSON COUNTY AUDITOR Address of assignee(number and street,city,state,and ZiP code) Does applicantpli own property in any If yes,what county? What Taxing District? Has this deduction been requested If yes,state amount of deduction otin Indiana? ❑Yes 0 No current property 0 Yes 0 No A person is not entitled to this deduction unless the person has a balance on the person's mortgage or contract indebtedness that is recorded in the county recorder's office(including any home equity line of credit that is recorded in the county recorder's office)that is the basis for the deduction. COUNTY AUDITOR Deduction approved in the amount of: 20 20 (" 20 20 20 •' 20` 20 Signature of Coyr►ty Aur�iito � C/''>►`� County • `\QcC or Date lay y ll. I/We certify under the penalty of perjury that the above and foregoing information is tnt a d correct and that the applicant is resid nt of Indiana and owner/contract buyer of the aforementioned property on date application is filed_ Signature( i a ) Date(month,/ day,year) r `l 4 �i !?�t'Cj Fu I resi e sg i ( u rand et,c' ,sta and ZlPcode) r ?..117,..) Pe n authorized by duly executed Power of Attorney or by iC 1.1 12-0.7 Date(month,day,year) Address of authorized person (number and street,city,state,and ZiP code) • The nenallies for cerium can include imprisonment ua to two and a half years and a fine not to exceed$10.000.